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LU anatomy review
~ left side – 2 lobes (cuz heart is in the way)
~ right side – 3 lobes
~ bronchi larger and horizontal on right side of LU – therefore easier to lodge things into
in the LU, psuedostratified ciliated columnar epithelium – these undergo hyperplasia in
smokers
~ metaplasia – changing from one cell type to another cell type (going from
pseudostratified to squamous)
~ in alveoli – simple squamous cells are there for diffusion of CO2 and O2
~ if there is too much pressure on liquid side of lungs, the liquid flows into tissues (which
is alveoli) = pulmonary edema
Atelectasis
~ Shrunken, airless state affecting all or part of LU
~ Collapsed LU – the collapsed lung resorbs and persistant infection causes damage to
the elastic fibers decrease in ability to maintain size widening of vessel
bronchiectasis
~ Acute or chronic
~ Get reduced oxygen = hypoxia
~ Anoxia = NO oxygen (very little chance of this happening in our body)
~ Chronic atelectasis, affected area is often composed of a complex mixture of
airlessness, infection, bronchiectasis, destruction, and fibrosis
Etiology of Atelectasis
Adults – chief cause of acute or chronic atelectasis is bronchial obstruction b/c:
~ 1) bronchial exudates plugs – infection and mucous
~ 2) tumours
~ 3) granulomas
~ 4) foreign bodies
Children – surfactant deficiency
~ Type I (regular cells) and Type II (surfactant secreting) alveoli
~ surfactant reduces surface tension in LU – allows LU to inflate
~ premie babies – have Type II but don’t secrete surfactant yet
~ or if you give them small toys and they swallow it
4 categories
~ 1) resorption – d/t obstruction (main one we’ll see)
~ 2) compression – d/t fluid or air in pleural cavity (between visceral and pleural layer)
~ 3) microatelectasis – in children because d/t decrease surfactant
~ 4) contraction – fibrosis causes LU to contract on itself
Atelectasis Pathophysiology
~ With the bronchial obstruction, there is less fresh air going into the lungs
~ this causes peripheral alveolar gas to be absorbed by the alveolar capillary blood
~ in a few hours, if there is no infection, the lung can shrink or collapse completely
~ Early stages – arterial hypoxemia
~ Slowly proceed into capillary and tissue hypoxia
~ This will lead to transudation of fluid and pulmonary edema
~ fluid in lungs means that there can’t be exchange of O2 and CO2 because the fluid is
pushed into the alveoli
~ the secretions will prevent complete collapse of atelectatic lung
~ But in the case of extensive collapse, diaphragm may elevate, chest wall will flatten,
and HT and mediastinum may shift toward collapsed side
~ bicarbonate is broken into carbon dioxide and water in the LU by carbonic anhydrase
~ bicarbonate is the main extracellular buffer
~ too much CO2 and H2 will cause acidic environment (acidosis)
~ blood pH is tightly regulated around 7.4 – if there is an acid environment, then there
may be an effect on enzymes = BIG problem
~ If the obstruction is removed, air complication may resolve, lung may return to normal
– but this depends on how complicated the infection is
~ If obstruction remains and infection is unresolved – lack of air and circulation leads to
fibrosis and bronchiectasis
Asthma
~ episodic
~ reversible bronchospasm
~ happens because of exaggerated bronchoconstrictor response
~ airway hyper-responsiveness to various stimuli
~ typically bronchodilate with epinephrine, which binds to adrenergic receptors
1) Extrinsic Asthma
~ anaphylactic – Type I hypersensitivity
~ Ab:Ag Rx – involving IgE , mast cells, histamine, eosinophils
~ IgE and eosinophiles are involved in allergies and parasites
~ mast cells degranulate and release histamine
~ histamine is involved in swelling, and it allows fluid to go from vessels into tissue
~ 3 types: atopic (skin), occupational (work related), allergic (peanut butter and shellfish
sandwich)
2) Intrinsic Asthma
~ non-immune triggers such as ASA (aspirin), pulmonary infections, psychological stress,
exercise
~ epinephrine and cortisol released in stress and exercise can cause inflammation
cascade
~ exercise can modulate the cortisol which may be beneficial if there is stress
COPD – Chronic Obstructive Pulmonary Diseases
Chronic bronchitis defined to be a chronic productive cough for at least 3 months in each
of 2 successive years for which other causes such as M. tuberculosis, lung carcinoma, or
chronic heart failure have been excluded
~ means that as long as you eliminate other disease that may lead to chronic bronchitis,
then the COPD is DUE to bronchitis and not a sequelae of something else
COPD – Bronchiectasis
~ Permanent dilation of bronchi and bronchioles caused by destruction of muscle and
elastic support tissue
~ parts of some airways are dilated mucous collects here more prone to infection
with infection you get inflammation more obstruction
~ Not really a primary disease, but usually secondary to persistent infections, obstruction
or congenital conditions
~ There is focal or widespread pathology – can affect multiple lobes in one or two lungs
COPD – Bronchiectasis Pathogenesis
1) Chronic persistent infections – sever pneumonia d/t staph, strep pneumococci and
(esp in children) H influenzae and Pseudomonas aeruginosa
2) bronchial obstruction – any cause (foreign body, enlarged lymph node, mucus
inpaction, lung tumour)
Penumoconioses
Keep in mind that “oses” very often refers to the lungs, but there ARE exceptions
~ Deposition of particles in trachea and bronchi may include these 3 responses:
~ 1) bronchoconstriction: Ag-Ab Rx or from irritation as reflex mechanism
~ 2) bronchitis: mucous gland hypertrophy and can lead to minor chronic airflow
obstruction
~ 3) lung CA: d/t of asbestos fibers or dusts with adsorbed radon daughters
Silicosis
Pneumoconiosis caused by inhaling crystalline free silica (silicon dioxide, quartz, “rocky
stuff”)
~ get discrete nodular pulmonary fibrosis
~ in more advanced stages – see conglomerate fibrosis and respiratory impairment
~ conglomerate fibrosis – fibrosis’ clumped together
Asbestosis
Long term inhalation of asbestos dust
Risk developing asbestosis, lung CA, mesothelioma
Asbestos is promoter, but not initiator, of carcinogenesis
Incidence of LU CA increased in smokers with asbestosis
Asbestosis Pathophysiology
Individual fibers of asbestos are inhaled deep into lung parenchyma
~ may lead to development of diffuse alveolar and interstitial fibrosis
~ you don’t feel the pain because there is no Meissner’s corpuscles or Merkel’s discs
in the LU – only stretch receptors
Asbestosis causes reduction in LU volume, compliance (ability to inflate LU), and gas
transfer chronically, can lead to hypoxia acidosis (you get the idea…)
Other Pneumoconioses
Berylliosis – Beryllium dust (Air plane manufacturing)
Byssinosis – bronchoconstriction occurring in cotton, flax, and hemp workers
Siderosis – iron dust
Goodpasteur’s Disease
Hypersensitivity disorder of unknown cause
~ Anti-glomerular basement membrane antibodies in blood
~ Ab that attacks glomerulus in KI damaged filtration
~ Linear deposition of immunoglobulin and complement in glomerular basement
membrane
~ Severe and progressive glomerulonephritis
~ Pulmonary hemorrhage
Pulmonary fibrosis
~ Often seen in diffuse parenchymal lung diseases
~ Affects the alveolar epithelium, pulmonary capillary endothelium, basement membrane,
perivascular and perilymphatic tissues
Causes:
~ inhaled stubstances: inorganic (asbestos, silica); organic (hypersensitivity pneumonitis)
~ drug induced: antibiotics, chemotherapeutic drug, antiarrhythmic drugs
~ connective tissue diseases: systemic lupus erythematosus, rheumatoid arthritis
~ infection: pneumonia, TB
~ indiopathic: sarcoidosis
~ certain malignancies
~ maybe autoimmune disorder??
Pulmonary fibrosis involves scarring of lung (above mentioned causes can all cause
scarring of lung)
~ Air sacs LU become replaced by fibrotic tissue decreased oxygen hypoxia
acidosis
Sarcoidosis
Immune system disorder
Non-necrotising gramulomas (small inflammatory nodules) – caused by overactive
lymphocytes
Causes dysregulation of Vitamin D production
Macrophages inside the granulomas convert Vit D into its active form
~ too much 1,25-dihydroxyvitamin D can cause fatigue, lack of strength, irritability,
metallic taste, cognitive problems
No direct cause has been identified
~ maybe because bacterial infection
~ maybe hereditary
~ maybe environment
Pneumonitis
~ hypersensitivity reaction
~ AKA extrinsic allergic alverolitis
~ inflammation of the alveoli within the lung caused by hypersensitivity to inhaled
organic dusts
~ characterized by the provoking antigen
~ can be acute or chronic